Methods:
Prospective study of 20 post-mortem porcine eyes implanted with the KAMRA inlay (AcuFocus, Irvine, CA) into a femtosecond laser-created lamellar pocket. Post-implantation eyes were treated with either the Catalys femtosecond laser (AMO, Santa Ana, CA) (n=8) , the LenSx femtosecond laser (Alcon, Ft. Worth, TX) (n=8) and the Ultra Q Nd:YAG laser (Ellex, Adelaide, Australia) (n=4). For the femtosecond laser treated eyes, each group was subdivided such that 2 eyes received a 5.0mm AC, 2 eyes received 3.0mm AC, 2 eyes received LF only, and the last 2 eyes received both LF and a 5.0mm AC. The PC treated eyes were subdivided into two groups of 2 eyes. PC was performed through the central aperture with the intention of not overlapping the inlay in 2 eyes. In the second group, PC was performed directly over the inlay.<br /> <br /> Changes to the inlay were evaluated in vivo and post-removal under the surgical microscope, at a slit-lamp and using SEM. Corneal histopathological exams were performed on the 4 PC eyes, 1 LF eye and 1 AC only eye.

Results:
Catalys and LenSx treated eyes showed no evidence of damage to the inlays either upon visual inspection or SEM analysis. Visual inspection and SEM analysis for the group where the YAG laser shots were fired through the aperture showed no signs of damage or thermal changes to the inlay or surrounding corneal tissue. In the 2 eyes where the laser was fired over the annulus, the inlays appeared rough and malformed. Histopathology results for these 2 eyes revealed areas of liberated pigment granules on the anterior stroma. No evidence of thermal damage was noted. The other 4 corneas showed neither signs of liberated pigment nor any thermal damage to the cornea.

Conclusions:
Corneal inlay and tissue integrity remain unchanged after performing AC and LF with a femtosecond laser. It is possible to focus and fire laser shots at the posterior lens capsule without damaging the inlay or surrounding corneal tissue. Conversely, application of Nd:YAG laser either directly upon or close proximity to the inlay may cause significant liberation of pigment granules into the surrounding corneal stroma, and disrupts inlay integrity. Further evaluation is needed.